Mylene Maria Victoriano, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME89920 Issued in FL

Practice address

909 Garden Gate Cir
Pensacola, FL 32504-8629

Phone

(850) 477-5475

Fax

(850) 477-8186

NPI assigned

Jun 15, 2006

Last updated

Jul 7, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Childrens Clinic of Pensacola PA

  • Pediatrics Physician
  • Pensacola, FL
  • NPI 1023256476
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1417991043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 GARDEN GATE CIR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048629",
            "telephone_number": "850-477-5475",
            "fax_number": "850-477-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 GARDEN GATE CIR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048629",
            "telephone_number": "850-477-5475",
            "fax_number": "850-477-8186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORIANO",
        "first_name": "MYLENE",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME89920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272000100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "01538",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST NETWORK",
            "identifier": "C865",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7406700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel T Vetrosky, PA
• Penelope Ann Vetrosky, CRNA
• Richard S Veyna, MD
• Elisabeth Burns Via, M.A.,CCC-A
• Victor Hultstrand LLC
• Ronald Parreno Victoriano, M.D.
• Victus Dental
• Victus Dental III PA
• Rikki A Vidak, LCSW
• Brent D Videau, MD

• Pediatrics Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.